, Volume 35, Issue 2, pp 147–150 | Cite as

Normal parathyroid hormone levels in a diabetic patient with parathyroid adenoma

  • Nese Ersoz Gulcelik
  • Fani Bozkurt
  • Gaye Güler Tezel
  • Volkan Kaynaroglu
  • Tomris Erbas
Original Paper


Objective The incidence of diabetes mellitus in patients with primary hyperparathyroidism and, conversely, primary hyperparathyroidism in diabetic patients are approximately threefold higher than the respective expected prevalence in the general populace. The diagnosis is straightforward when the patient presents hypercalcemia and inappropriately elevated serum parathyroid hormone (PTH) levels. We report a case of parathyroid adenoma in a diabetic patient with persistent hypercalcemia and normal PTH levels. Patient A 50-year-old female patient who was referred to our outpatient clinic presented with persistent hypercalcemia (serum Ca levels between 10.5 and 11 mg/dl) with a normal serum intact PTH level of 46.1 pg/ml. Her blood pressure was 120/80 mmHg, and she was being treated with antihypertensive therapy. Her HbA1c was 7.2%, and her triglycerides were in the normal range. A bone densitometry exam revealed osteopenia of radius −1.39, femoral neck −1.39, and the total hip −1.04. A neck ultrasound revealed a mass of 13 mm next to the inferior and posterior of the right thyroid lobe. A dual phase Tc-99m-sestamibi scan revealed an area of increased uptake in the same region, which is indicative of a parathyroid adenoma. The parathyroid adenoma was removed, which resulted in the achievement of normocalcemia. Conclusion Diabetic patients should be evaluated for hyperparathyroidism as associated hypertension can complicate the course of the disease. These patients should be evaluated for primary hyperparathyroidism when they exhibit persistent hypercalcemia and when clinical suspicion is aroused even if the serum PTH levels are within the normal range.


Parathyroid adenoma Diabetes mellitus Hypercalcemia 


  1. 1.
    S.J. Silverberg, Diagnosis, natural history, and treatment of primary hyperparathyroidism. Cancer Treat. Res. 89, 163–181 (1997)PubMedGoogle Scholar
  2. 2.
    S. Werner, B. Hjern, H.E. Sjoberg, Primary hyperparathyroidism: analysis of findings in a series of 129 patients. Acta Chir. Scand. 140, 618–625 (1974)PubMedGoogle Scholar
  3. 3.
    S. Ljunghall, M. Palmer, G. Akerstrom, L. Wide, Diabetes mellitus, glucose tolerance, and insulin response to glucose in patients with primary hyperparathyroidism before and after parathyroidectomy. Eur. J. Clin. Invest. 13, 373–377 (1983)CrossRefPubMedGoogle Scholar
  4. 4.
    P.S.Y. Cheung, N.W. Thompson, T.E. Brothers, A.I. Vinik, Effect of hyperparathyroidism on the control of diabetes mellitus. Surgery 100, 1039–1047 (1986)PubMedGoogle Scholar
  5. 5.
    W.H. Taylor, A.A. Khaleeli, Prevalence of primary hyperparathyroidism in patients with diabetes mellitus. Diabet. Med. 14(5), 386–389 (1997)CrossRefPubMedGoogle Scholar
  6. 6.
    W.H. Taylor, A.A. Khaleeli, Coincident diabetes mellitus and primary hyperparathyroidism. Diabetes Metab. Res. Rev. 17(3), 175–178 (2001)CrossRefPubMedGoogle Scholar
  7. 7.
    D.T. Holmes, A. Levin, B. Forer, F. Rosenberg, Preanalytical ınfluences on DPC IMMULITE 2000 ıntact PTH assays of plasma and serum from dialysis patients. Clin. Chem. 51, 915–917 (2005)CrossRefPubMedGoogle Scholar
  8. 8.
    P. McNair, M.S. Christensen, S. Madsbad, C. Christiansen, Hypoparathyroidism in diabetes mellitus. Acta Endocrinol. 96, 81–86 (1981)PubMedGoogle Scholar
  9. 9.
    S.J. Silverberg, P. Gao, I. Brown, P. Logerfo, T. Cantor, J. Bilezikian, Clinical utility of an immunoradiometric assay for parathyroid hormone (1–84) in primary hyperparathyroidism. J. Clin. Endocrinol. Metab. 88, 4725–4730 (2003)CrossRefPubMedGoogle Scholar
  10. 10.
    P.C. Kao, J.A. van Heerden, C.S. Grant, G.G. Klee, S. Khosla, Clinical performance of PTH immunoradiometric assays. Mayo Clin. Proc. 67, 634–645 (1992)Google Scholar
  11. 11.
    F.W. Lafferty, C.R. Hamlin, K.R. Corrado, A. Arnold, J.M. Shuck, Primary hyperparathyroidism with a low normal, atypical serum parathyroid hormone as shown by discordant immunoassay curves. J. Clin. Endocrinol. Metab. 91, 3826–3829 (2006)CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nese Ersoz Gulcelik
    • 1
  • Fani Bozkurt
    • 2
  • Gaye Güler Tezel
    • 3
  • Volkan Kaynaroglu
    • 4
  • Tomris Erbas
    • 1
  1. 1.Department of Endocrinology and MetabolismHacettepe University Medical SchoolAnkaraTurkey
  2. 2.Department of Nuclear MedicineHacettepe University Medical SchoolAnkaraTurkey
  3. 3.Department of PathologyHacettepe University Medical SchoolAnkaraTurkey
  4. 4.Department of General SurgeryHacettepe University Medical SchoolAnkaraTurkey

Personalised recommendations